Surgery for obesity? When is it appropriate?

It's a stunning statistic: According to recent federal guidelines, more than half of American adults are overweight or obese.

Surgery to reroute the digestive system or limit the amount of food that can be eaten at one sitting is not for everyone who's overweight. But it can be effective for those who are severely obese.

Not only can it promote significant weight loss, but it often results in a reversal of weight-related chronic health conditions.

Defining the problem

Weight-reduction surgery is not cosmetic surgery. Rather, it's intended for severely obese people who have weight-related chronic health conditions.

Essentially, individuals who are 100 percent or more over their ideal weight or at least 100 pounds overweight are considered severely obese. Weight-related health conditions, including high blood pressure, heart disease, diabetes, arthritis and sleep apnea, are important indicators as well.

Such chronic health conditions associated with severe obesity increase chances for early death. As a result, these conditions may signal a need to consider a surgical route to weight reduction.

Surgery can be an important aspect in treatment. But success also depends on a person's determination to change his or her eating behavior and a commitment to lifelong follow-up. Surgery doesn't replace the importance of diet and exercise in weight management.



Vertical banded gastroplasty and the Roux-en-Y are two common types of weight-reduction surgery.

Types of surgery

The most common types of weight-reduction surgery promote weight loss by either:


Restricting food intake ? Restrictive procedures create a small pouch at the top of the stomach and narrow opening to the stomach so you can't eat as much or as quickly. The outlet is only about the diameter of a dime.
Unless very small amounts of food are eaten and chewed well, vomiting is a common side effect.

The most frequently used gastroplasty technique is called vertical banded gastroplasty (see illustration). The small pouch only holds about 1 ounce, eventually expanding to 2 to 3 ounces over time (compared to the usual stomach capacity of about 3 pints).

Bypassing the normal digestive process ? Gastric bypass procedures create an extremely small pouch for food entering the stomach and connect that pouch directly to the small intestine. The connection bypasses most of the stomach and the first portion of the intestinal tract.
These procedures not only restrict food intake but limit the absorption of nutrients. For that reason, some vitamin and mineral supplements may be required.

This type of surgery ? as compared to gastroplasty ? usually results in greater weight loss and more success in maintaining a satisfactory weight loss. However, gastric bypass may cause "dumping syndrome" ? nausea, cramping and diarrhea ? especially if high-calorie sweets are eaten.

The most common gastric bypass procedure is the Roux-en-Y (roo-en-why).

There are several other surgical procedures for weight reduction, but they're either used infrequently or are still being studied.


Measuring success

Weight-loss surgery isn't for everyone. But when appropriate, it can result in dramatic improvements in weight and health.

In the first 12 to 24 months, most people lose 50 to 60 percent of their excess weight. Generally, those who follow dietary and exercise recommendations keep most of that weight off long-term.

The effect on chronic health conditions related to severe obesity can also be significant. For example, people who are severely obese and have type II diabetes (adult-onset) nearly always see a major improvement after surgery.

In addition, high blood pressure disappears in about two-thirds of people who have weight-reduction surgery, and many with sleep apnea enjoy marked improvement.